Expanding Medicaid The Who, What, When and How of LB 887.

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Presentation on theme: "Expanding Medicaid The Who, What, When and How of LB 887."— Presentation transcript:

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Expanding Medicaid The Who, What, When and How of LB 887

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Sections of LB 887 Section 1 – Name of the Act Section 2 – Findings Section 3 – Purpose Section – Definitions Section 36 – State plan amendment -Directs DHHS to apply for a state plan amendment that will be in effect until WIN waivers are enacted. -Directs DHHS to apply for waivers to implement WIN, -Permits DHHS to establish a employer-sponsored insurance premium assistance if cost effective

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Sections of the Bill (continued) Section 37 – Marketplace coverage -100%-138% of FPL and no exceptional medical conditions -Enroll in a 100% actuarial value silver plan -Effective first day of month following month of application -Medicaid coverage until effective date and wraparound coverage for MA services not covered by QHP

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Sections of the Bill (continued) Section 38 – Employer sponsored insurance -Available to persons up to 138% of FPL who have access to coverage through an employer that meets ACA standards. -DHHS may pay for premium associated with employer share of premiums, cost sharing and wrap around benefit. -Employer sponsored insurance shall only be provided if determined to be cost effective.

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Sections of the Bill (continued) Section 39 – WIN Medicaid -Available to those with incomes below 100% of FPL. -Private managed care organizations providing WIN Medicaid coverage must assure that newly eligible have access to a primary care provider and enrolled in a patient-centered medical home, where available.

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Sections of the Bill (continued) Section 44 – Conditions of participation -A member is eligible for benefits for 12 months from initial enrollment. -Annual review of eligibility. -Coverage can be cancelled if program is discontinued. Section 45 – Content of waiver application

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Sections of the Bill (continued) Section 46 – WIN Oversight Committee -Chair of HHS Committee -Two members of HHS Committee -Two members of Appropriations Committee -Two members of Banking, Commerce and Insurance Committee -Two members not on those committees -Meet quarterly with representative of DHHS

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Who Would be Covered by LB 887 WIN coverage would be offered to Nebraskans with MAGI below 138% of FPL. – Premium support for employer sponsored coverage – Premium support for marketplace coverage for those between 100% and 138% of FPL – Medicaid coverage for those below 100% of FPL

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Three Types of Coverage Employer Sponsored Insurance Option that could be used if it is cost-effective DHHS would pay employee costs of coverage WIN Marketplace Premium support to buy a special issue plan Wraparound coverage for MA-only services WIN Medicaid Medicaid coverage extended to newly eligible